Background Accurate intraoperative detection of nociceptive events is essential for optimizing analgesic administration and improving postoperative outcomes. While deep learning models promise to capture complex temporal dynamics of physiological signals, their added complexity may not always yield clinically meaningful gains compared to well-engineered classical approaches.

Methods We evaluated two classical supervised models—L1-regularized logistic regression and Random Forests (with and without drug dosing features)—against a Temporal Convolutional Network (TCN) transfer-learning framework. We used a dataset of 101 adult surgical cases (~50,000 annotated nociceptive events over ~18,500 minutes) sourced from PhysioNet that tracked 30 physiologic and 18 drug-related features in 5-second windows. All models were assessed under a leave-one-surgery-out cross-validation, with AUROC and AUPRC as primary metrics. We further examined probability calibration (Platt scaling, isotonic regression) and four ensemble strategies—including a meta-learner, MLP, and a feature-conditioned gated network—to quantify the benefit of deep personalization.

Results Drug-aware Random Forests achieved the highest discrimination (AUROC 0.716; AUPRC 0.399), significantly outperforming the TCN transfer-learning model (AUROC 0.649; AUPRC 0.311). Isotonic calibration reduced expected calibration error by over 80% but did not alter discrimination. None of the ensemble methods surpassed the standalone Random Forest, and the gated network consistently assigned > 84% weight to the classical model. Permutation importances revealed critical mechanistic features related to sympathetic physiologic response.

Conclusions In this head-to-head benchmark, interpretable classical models on expertly curated features matched or exceeded the performance of a complex deep learning approach, while offering superior computational efficiency and transparency. These findings underscore the importance of rigorous comparative evaluation before adopting high-complexity AI solutions in clinical practice.

Data Availability Statement All data was sourced from Subramanian et al. on PhysioNet under data usage agreement and proper citations in the manuscript. All code and analysis can be provided upon reasonable request. The authors plan to upload their code on GitHub.

Competing Interests Statement The authors declare no conflict of interests or financial stakes in this work.

Funding Disclosures There is no funding to declare for this work.

The authors have declared no competing interest.

There is no funding to declare for this work.

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